Application Intervention® Intake Form It’s important that we have the completed intake form in advance of your call so that Kaneisha has the information she needs to ask you the right questions. Application Intervention® Intake Form Name* First Last Name you prefer to be called*Birthday (excluding year)*(MM/DD)Current Age*Phone Number*Best email to send you messages* Email address you use for Google Drive (Google Docs)*Please indicate a gmail account. Best Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Emergency Contact Policy: In the event that The Art of Applying is concerned that Client is in danger or is in danger of harming someone else, Client authorizes The Art of Applying to contact emergency services and/or Client's Emergency Contacts, and to provide them with any appropriate information relevant to the situation, including releasing Client's Emergency Contact information to emergency services. Client acknowledges that The Art of Applying is not providing psychotherapy or mental health counseling and is under no legal duty to report.*Select one.I agree to the Emergency Contact Policy.I do not agree to the Emergency Contact Policy.Emergency Contact #1* First Last Emergency Contact #1's relationship to you*Emergency Contact #1's phone number*Emergency Contact #1's email address* What is your country of citizenship?*What city, state, and country do you LIVE IN NOW?*Where did you go for college?*What was your major in college?*What was your GPA in college?*Which of the following courses have you taken and earned a B or better?*Some of these courses are recommended for increasing your competitiveness and preparation for top policy school and business school programs. Statistics Macroeconomics Microeconomics Accounting Finance Multivariable Calculus None of the above. If you have additional degrees, list them here.*Which schools do you plan on applying to?*To which degree(s) are you applying?*Strengths you would like to highlight in your application*Do you have any potential "red flags" with your candidacy (i.e. failing grades, low test scores, legal issues, etc.)?*What is your current employment status?*Choose one.Employed Full-TimeEmployed Part-TimeFull-Time Temporary ContractorPart-Time Temporary ContractorSelf-employedNot employed but looking for workNot employed and not looking for workHomemakerRetiredStudentWhat is your current profession?*How many years of post-college full time work experience will you have when you submit your applications?*What is your dream job right after graduation from graduate school? (Graduation - 5 years out)*What is your ultimate long-term dream job?Notes about your personal and professional backgroundFeel free to upload a resume if you like.Which tests have you taken?* GRE GMAT LSAT MCAT TOEFL / IELTS Executive Assessment None How many times have you taken the above exam(s) in the past?*Provide test scores for tests you've taken:Which tests do you plan to take in the next 12 months?* GRE GMAT LSAT MCAT TOEFL / IELTS Executive Assessment None What books, classes, programs, or resources are you currently using or plan to use to study for the tests you plan to take?What are the top 3 things you would like to accomplish during your Application Intervention®?*What are your current questions for Kaneisha?*Would you like to add anything else?You're welcome to add in any questions, clarifcations or inquiries you have on your client folder as well.
